197609785-9-14-2022-31-AS-RRAZ-CL84LP-20221115181212

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609785
Report Date: 09/14/2022
Date Signed: 09/14/2022 05:01:45 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/23/2021 and conducted by Evaluator Rosaura Valenzuela

COMPLAINT CONTROL NUMBER: 31-AS-20211123140157

FACILITY NAME:	EATON CANYON VILLAS I		FACILITY NUMBER:	197609785
ADMINISTRATOR:	GARIBYAN, ARMOND		FACILITY TYPE:	740
ADDRESS:	2518 GANESHA AVE		TELEPHONE:	(818) 429-0070
CITY:	ALTADENA	STATE: CA	ZIP CODE:	91001
CAPACITY:	6	CENSUS: 6	DATE:	09/14/2022
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Aura Amaya-Lopez		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff mishandle a resident's medications while in care

Staff do not provide adequate care and supervision to a resident

Staff are interfering with a resident's doctor's appointment's

INVESTIGATION FINDINGS:

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Licesning Program Analyst (LPA) Rosaura Valenzuela conducted an unannounced subsequent visit for the above noted allegations. LPA met with manager Aura Amaya-Lopez, The purpose of the visit was discussed.

It was reported that staff mishandle a resident's medications while in care. To investigate the allegation during this visit on 9/14/2022, between, 2:30pm and 3:30 staff and resident interviews were conducted, Staff interviews revealed that Resident #1 (R1) is no longer living at the facility. Staff were able to recall that R1 at times refused to take their medication. 4 out of 6 residents interviewed stated that they have not experienced any problems with the administration of their medication.

Basesd on interviews and due to absence of facility file there is not sufficient information to support this allegation. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura Valenzuela	TELEPHONE: (818) 421-5360
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20211123140157

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: EATON CANYON VILLAS I	FACILITY NUMBER: 197609785
	VISIT DATE: 09/14/2022

NARRATIVE

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It was alleged that staff do not provide adequate care and supervision to a resident . To investigate this allegation on 9/14/2022, between 2:30pm and 3:30pm, LPA interviewed staff and residents. Staff interviews revealed that they do provide care and supervision to all residents. Staff noted that they have sufficient employees to assist the residents. Facility is not short staffed. Resident interviews confirmed what staff stated.. 4 out of 6 residents interviewed said staff are always present and available when required.

Based on observation and interviews, there is not sufficient information to support this allegation. Therefore, it is deemed UNSUBSTANTIATED at this time.

It was reported that staff are interfering with a resident's doctor's appointment's. To investigate this allegation on 9/14/2022, between 2:30pm and 3:30pm, LPA interviewed staff and residents. Staff interviews revealed that the facility does not provide transportation to medical appointments, but that they can arrange for transportation to doctor appointments if needed. Staff state that residents can see their doctors when they want to see them. Residents interviewed confirmed what staff said. 4 out of 6 residents interviewed denied that staff prevent them from seeing their doctors. They said that they see their doctors when they need to.

Based on interviews, there is there is not sufficient information to support this allegation. Therefore, it is deemed UNSUBSTANTIATED at this time.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura Valenzuela	TELEPHONE: (818) 421-5360
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2022

LIC9099 (FAS) - (06/04)

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